Clinical Values Of Urinary TGF-β₁, MIP-1α And NGAL Level In Lupus Nephritis

Systemic lupus erythematosus (SLE) is an character as multi-organ and multi-sys-tem autoimmune diseases. Kidney commonly is the organ mostly involved. About70%of the SLE patients complication lupus nephritis (LN), while postmortem examinations found almost100%patients have kidney involvement. At present, renal biopsy is the "gold stan-dard" for diagnosing LN. It can identify pathological types and predict the prognosis. As the risk of bleeding due to thrombo-cytopenia, and the common use of glucocorticoid and/or immunosuppressive, and working habits of inferring pathology types according to the clinical data, renal biopsy rate in LN is less than other glomerulonephritis. Therefore it is becoming a hotspot home and abroad to find urinary markers to predict the renal pathological changes. Objective To determine whether there is correlation between pathological classification, clinical situation, treatment reflects and urinary level of TGF-β1, MIP-1α, and NGAL in LN. Method The LN group is combined of36LN patients who meet the1997ACR diag-nostic criteria and had renal biopsy from November2008to December2009. As the control group we select①37cases of other glomerulonephritis at the same time, who all meet uni-versal diagnostic criteria, including8with purpura nephritis,16with IgA nephropathy and13with primary glomerulonephritis;②20SLE patients without renal damaged;③10nor-mal controls. Use ELISA to test the levels of urinary level of TGF β1, MIP1α and NGAL of the subjects. Analyze the correlation between these three urinary markers, and the pathological types, acute and chronic pathological index score, histological semi-quantita-tive score and clinical data. Results①There is significant difference of urinary TGF β1, MIP-1α, and NGAL levels when compare the LN group, the normal control group and without renal damage SLE patients group (F value is15.88,6.49and35.95, respectively, all P<0.05), While there is no significant difference between LN group and other glomeru-lonephritis.②There is significant difference of the three urinary markers when classficated LN patients on pathological types, but no difference between the LN group and the other glomerulonephritis group.③Analysis of the correlation between the three urinary markers and semi-quantitative histopathological score of the LN patients showed that, urinary level of TGF-β1and increment of mesangial matrix area, glomerular chronicity index, tubular atrophy and interstitial fibrosis, vascular chronicity index are closely related (r value is0.57,0.78,0.69and0.53, respectively, all P<0.01), urinary MIP-1α and endothelial prolifera-tive index, active crescents and segmental necrosis of glomerular capillary wall, vascular chronicity index is closely related (r value is0.50,0.82and0.41, respectively, all P<0.05), while urinary NGAL is closely related with endothelial proliferative index, active cres-cents and segmental necrosis of glomerular capillary wall and mesangial hypercellularity index (r value is47,0.57and0.45, respectively, all P<0.05). The correlation between the three urinary markers and acute and chronic pathological index score of the LN patients showed that TGF-β1is correlated with the chronic index,(r=0.89, P<0.05), the MIP-1α and NGAL are significantly correlated with the activity index,(r values is0.71and0.60, both P<0.05).④there is correlation between urinary level of TGF-β, NGAL and24h urine protein (r value is0.34and0.28, both P<0.05), and so is the urinary MIP-1α, urinary NGAL and serum IgG (r values is0.57and0.35, both P<0.05). Meanwhile, post-treatment urinary MIP-1α and serum IgG have a correlated(r=0.47, P<0.05). TGF-β1and24h urine protein after treatment have a correlation(r=0.51, P<0.01). Conclusion①The levels of urinary TGF-β1, MIP-1α and NGAL in glomerulonephritis are higher than both the SLE patients without renal damage and the normal.②There is positively correlation between urinary TGF-β1level and renal mesangial, mesangial, glo-meruli and matrix proliferation and with chronic kidney disease. The urinary MIP-1α and NGAL are associated with renal activite damage.③There is correlation between the urinary TGF-β1, NGALand24h urine protein in LN group, so is urinary MIP-1α, NGAL and se- rum IgG. At the same time the level of post-treatment urinary TGF-β1descended as de-scending of24h urinary protein and the level of urinary MIP-1α descended after therapy in response to the descending of IgG. To some extent urinary TGF-β1, MIP-1α and NGAL may be as indictors of monitor disease activity and treatment response.